The incidence of drug-induced injury is high in the ambulatory geriatric population and is[unreadable] increased for elders upon transition from the hospital to the ambulatory setting. In this[unreadable] application, we describe an effort to build on our extensive experience in medication[unreadable] safety and HIT-based medication management to respond to the AHRQ RFA entitled[unreadable] Ambulatory Safety and Quality Program: Improving Quality through Clinician Use of[unreadable] Health IT (RFA-HS-07-006). In this study, we propose to develop and evaluate the[unreadable] value of an enhanced, HIT-based medication reconciliation system superimposed on the[unreadable] ambulatory electronic medical record (EMR) to improve the quality and safety of[unreadable] medication management, focusing particularly on the transition from the inpatient to the[unreadable] ambulatory setting for older adults with multiple comorbid conditions who are prescribed[unreadable] high risk medications. We propose a randomized controlled trial of a HIT-based[unreadable] transitional care intervention with enhanced medication reconciliation and therapeutic[unreadable] monitoring alerts to improve the quality and safety of patient monitoring and medication[unreadable] management. We postulate that the efficient and coordinated delivery of actionable[unreadable] health information to the clinician via use of HIT in the ambulatory setting can improve[unreadable] medication safety for the growing geriatric population. The specific aims for this study[unreadable] are to evaluate, among a population of older adults discharged from the hospital, the[unreadable] impact of an enhanced medication reconciliation system initiated upon transition to the[unreadable] ambulatory setting: (1) on the rate of follow-up by an outpatient provider within 14 days[unreadable] of hospital discharge; (2) on the prevalence of appropriate monitoring for selected high[unreadable] risk medications at 30 days from the time of hospital discharge; (3) on the incidence of[unreadable] adverse drug events (ADEs) 30 days after discharge; and (4) on the rate of[unreadable] emergency department visits and hospital readmission within 30 days of discharge. A[unreadable] secondary aim for this study is to determine costs directly related to the development[unreadable] and installation of the HIT-based transitional care intervention. This research allows for[unreadable] the examination of an integrated HIT intervention on the quality of follow-up, outpatient[unreadable] clinician workflow, occurrence of ADEs, and health care utilization to gain insights into[unreadable] the effective use of clinical alerts and coordinated delivery of actionable information to[unreadable] outpatient clinicians in the management of ambulatory elderly patients subsequent to[unreadable] hospital discharge.